Lymph node removal (lymphadenectomy)

Expert reviewer, Mr Christian Macutkiewicz, Consultant General and Hepato-Pancreatico-Biliary Surgeon
Next review due March 2023

Lymph node removal is a surgical procedure to take out one or more of your lymph nodes. Your doctor may recommend you have this procedure if you’ve been diagnosed with cancer.

There are two main reasons for removing lymph nodes.

  • If you have cancer, one or more lymph nodes may be removed to check whether it has spread. Knowing this helps your doctor plan the best treatment for you.
  • If tests have shown that the cancer has reached your lymph nodes, you may have them taken out to remove the cancer. This helps to reduce the chance of your cancer coming back.

Here we’ll give a general overview of lymph node removal. Your experience may be different depending on the type of cancer you have and your individual circumstances.

An image showing a diagram of the lymphatic system

What are lymph nodes?

Lymph nodes are small, kidney bean-shaped organs found throughout your body, including your armpits, neck and groin. They are part of the lymphatic system. This is a network of thin tubes that carries a clear fluid called lymph from around your cells to your bloodstream. Your lymph nodes help to fight infection and filter lymph fluid. They trap any bacteria and waste products in lymph and destroy old or abnormal cells, such as cancer cells.

Many types of cancer spread through the lymphatic system and nearby lymph nodes are one of the first places they spread to. So, taking out a lymph node to check for cancer cells can be a good way to show if your cancer has spread. See our FAQ below to find out which cancers are most likely to spread to your lymph nodes.

Medical terms used in lymph node removal

You may hear a number of different medical terms used when describing lymph node removal. Here are some of the most common ones and what they mean.

  • Lymphadenectomy – the medical term for lymph node removal.
  • Lymph node (excision) biopsy – just one node is removed to check for cancer cells.
  • Sentinel lymph node – this is the first lymph node your cancer is likely to spread to.
  • Sentinel lymph node biopsy – removal of the sentinel lymph node. See our FAQ below for more information on sentinel lymph node biopsy.
  • Lymph node dissection (or clearance) – this is when many lymph nodes are taken out together. An example is axillary lymph node dissection for breast cancer. In this procedure, your surgeon removes a number of lymph nodes from your armpit (axilla).

Preparing for lymph node removal

Your hospital will give you information about your procedure, including how to prepare for it. You’ll probably be invited to a pre-admission assessment clinic at the hospital a week or two before the date of your operation. A nurse will check your general health and may do some tests, including blood tests.

If you smoke, you’ll be asked to make every effort to stop before your procedure. This is because smoking increases your risk of getting a chest and wound infection, which can slow down your recovery.

If you’re going to have a general anaesthetic, your hospital will give you clear instructions on when to stop eating and drinking. This is usually from around six hours before your procedure – but always follow the advice you’re given.

Your nurse or surgeon will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you’re happy to give your consent for the procedure to go ahead. You’ll be asked to do this by signing a consent form.

Your nurse will prepare you for your operation. You may be asked to wear compression stockings, which help prevent blood clots forming in the veins in your legs.

What happens during lymph node removal?

The anaesthetic you have will depend on exactly what procedure you’re having. Although you can have a local anaesthetic for some procedures, if you’re having many lymph nodes removed, you’ll probably have general anaesthesia. This means you’ll be asleep during the procedure.

Exactly what happens next will depend on a number of things, including how many lymph nodes are being removed and where they are. Your surgeon will explain beforehand what your operation will involve.

If you’re having a sentinel lymph node biopsy, you may have a scan before your operation to help your surgeon find the sentinel node. For more information, see our FAQ: What happens in a sentinel lymph node biopsy? below.

In most cases, your surgeon will make a small cut in the affected area and identify the lymph nodes they are going to remove. They’ll then carefully remove them and possibly some other tissue nearby that may have cancer cells. Your surgeon may use a fine tube (drain) to drain fluid from your wound. The drain may be left in place for a few days. Finally, your surgeon will close the cut with dissolvable stitches, non-dissolvable stitches or staples.

Sometimes it’s possible to have keyhole surgery instead. In keyhole surgery, your surgeon will make a small cut (or cuts) and pass surgical instruments (including a camera) through these. They’ll use images on a monitor to see your lymph nodes and remove them.

After surgery, your lymph nodes will be sent to a laboratory to see if there are any cancer cells in them.

Aftercare for lymph node removal

How long you need to stay in hospital depends on the type of lymph node removal operation you had. You might be able to go home the same day or you may need to stay longer. Ask your surgeon how long you’ll need to stay in hospital for.

If you had a local anaesthetic, you’ll need to take it easy until feeling returns to the area. Be careful not to bump the affected area. Similarly, if you had a general anaesthetic, you’ll need to rest until all the effects wear off. You might have some discomfort as this happens, but you’ll be offered pain relief.

If you had a general anaesthetic and are able to go home the same day, you’ll need to arrange for someone to drive you home. This is a good idea even if you had a local anaesthetic. Try to have a friend or relative stay with you for the first 24 hours after you get home.

Having a general anaesthetic affects everyone differently and in ways you may not expect. You might find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.

You’ll be given advice about caring for a surgical wound before you go home, as well as a date for a follow-up appointment.

If you have a drain from your wound, it will usually be removed after a few days. You might be able to go home with the drain in place. A practice nurse at your GP surgery or a district nurse may then visit you at home to remove it. You’ll have a dressing covering your wound. Your nurse or surgeon will tell you when you can remove this.

If your surgeon used dissolvable stitches to close your cut, these won’t need to be removed. They will dissolve completely within a week to three months depending on which type your surgeon used. If you had non-dissolvable stitches or staples, you’ll need to have these removed 10 days to two weeks after your operation.

It may take up to two weeks for the laboratory test results to come back. Results are usually sent to the doctor who requested your procedure. The results will tell your doctor if cancer cells were found in your lymph nodes. Your doctor will talk to you about your results at your follow-up appointment.

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Recovering from lymph node removal

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

How long it will take to recover and get back to normal after lymph node removal surgery will vary depending on your circumstances. Ask your surgeon when you’re likely to be able to get back to your usual activities, including returning to work. Check if there are any restrictions on what you can do for a while – for instance, strenuous exercise or heavy lifting. Always follow your surgeon’s advice.

Side-effects of lymph node removal

Like all procedures, lymph node removal can cause some side-effects, but these are mostly temporary. After having your lymph nodes removed, you may have:

  • pain, swelling and bruising
  • stiffness and reduced movement

Complications of lymph node removal

Complications are when problems occur during or after the operation. Complications of having your lymph nodes removed can include:

  • an infection in your wound – this may mean you need antibiotics
  • a build-up of fluid in the lymph node area (seroma) – this usually goes within a few weeks but your surgeon may need to drain it
  • injury to nerves near the site of your operation – this may make your skin feel numb
  • a slow build-up of fluid causing swelling in the affected arm or leg over months or years – this is called lymphoedema; for more information on this, see our section on long-term effects below

Long-term effects of lymph node removal – lymphoedema

If you have one or more lymph nodes removed, there is a risk of some long-term effects. One of these is a condition called lymphoedema, which is swelling of part of your body due to poor drainage of lymph fluid. It can affect any part of your body but often happens in your arm or leg. You’re more likely to develop this condition if you have several lymph nodes removed and had radiotherapy treatment for cancer afterwards.

Lymphoedema happens when your lymphatic system can’t transport lymph fluid around your body properly. Having surgery to remove lymph nodes can disrupt your lymphatic system, and cause a build-up of lymph. The lymph may collect in your tissues and cause swelling. The waste products contained in the blocked lymph can add to the swelling in surrounding tissues.

You’ll continue to be at risk of developing lymphoedema for the rest of your life after having lymph nodes removed. But there are many things you can do to keep this risk as low as possible, and it’s important that you do these. They range from keeping healthy by exercising and eating a healthy diet to looking after your skin, wearing compression stockings, and attending follow-up medical appointments with your doctor.

Frequently asked questions

  • If you have cancer, your doctor may recommend removing one or more of the lymph nodes closest to the site of your cancer. This is because cancer often spreads to other parts of your body through your lymphatic system. Your lymph nodes may be removed to find out if the cancer has spread or because it already has. The most common cancers for which lymph nodes are removed include:

  • A sentinel lymph node is the first lymph node a cancer is likely to spread to. Your surgeon may recommend taking out this node to see if it has any cancer cells in it. This procedure is called a sentinel lymph node biopsy. It helps your doctor decide on the best treatment for you. It’s usually done if you have breast cancer or melanoma (skin cancer).

    Before they can remove the sentinel node, your surgeon has to find it. To help them do this, you may have a scan in the nuclear medicine department of the hospital. This will be done by a radiographer (a health professional trained to perform imaging procedures). The scan may happen the day before or on the morning of your surgical procedure.

    Your radiographer will inject small amounts of a radioactive liquid into the area near your cancer but don’t worry, the radioactivity you get is less than with a normal X-ray. About 15 minutes later, you’ll have a scan. This picks up the radioactivity and follows it on its path to your lymph nodes. The first lymph node that the radioactive liquid goes into is the sentinel node. Your radiographer may mark its position on your skin for your surgeon to see.

    During your surgery, your surgeon may also inject a special blue dye into the area of your cancer. This travels to the sentinel lymph node and dyes it blue, which makes it easier for your surgeon to find it.

    Once they locate the sentinel lymph node, your surgeon will surgically remove it and send it to the laboratory. If there are no cancer cells present, this may mean you don’t have to have any more lymph nodes removed.

  • No, having swollen lymph nodes doesn’t necessarily mean that you need to have them removed. It may be the case if you have cancer, but swollen nodes are usually caused by other things. The most common cause is an infection, because the cells in nearby lymph nodes filter out and fight the infection. For example, a throat infection might cause swollen nodes in your neck. Some medical conditions cause swollen nodes in many parts of your body at one time. This is most likely to be due to an infection such as glandular fever.

    Some of the causes of swollen lymph nodes get better on their own and some need treatment. If you notice that your nodes remain swollen for six weeks or more or you notice a new lump somewhere in your body, contact your GP.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, March 2020
    Expert reviewer, Mr Christian Macutkiewicz, Consultant General and Hepato-Pancreatico-Biliary Surgeon
    Next review due March 2023